Association Between the Distributions of Mean Corpuscular Hemoglobin and Red Blood Cell, and Mortality in a 3-Year Retrospective Study of Hemodialysis Patients

Abstract

Introduction: A red blood cell (RBC) concentration of 300 to 350×10⁴/μL and mean corpuscular hemoglobin (MCH) concentration of 30 to 35 pg have been proposed as management target values from the relationship of Hb=RBC×MCH to control anemia, wherein Hb levels should not exceed 12 g/dL. In contrast, even in patients whose Hb levels are maintained at 10 to 12 g/dL, Hb levels are widely distributed when divided into RBC and MCH. Objective: We examined the prognosis in the distribution of MCH and RBC. Methods: Patients were classified into two groups based on MCH and RBC values, wherein patients with MCH≥30 pg but<35 pg and RBC≤350×10⁴/μL (Group I, n=177); and MCH<30 pg and RBC>350×10⁴/μL (Group II, n=217). Associations between all-cause mortality and the distributions of MCH and RBC as well as the iron profiles of these two groups were assessed by Kaplan-Meier curves and Cox proportional hazards regression model, respectively. Results: Patients with MCH<30 pg and RBC>350×10⁴/μL (Group II, n=217) had an increased long-term risk of death and a higher rate of iron deficiency than patients with MCH≥30 pg but<35 pg and RBC≤350×10⁴/μL (Group I, n=177). Conclusions: The management goal for renal anemia would be to control MCH within the range of 30−35 pg and RBC within the range of 300−350×10⁴/μL, and to avoid absolute iron deficiency.